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Trancatheter Aortic Valve Implantation

(TAVI)

Georgios I. Papaioannou, MD, MPH, FACC, FSCAI

Director, Interventional Cardiologist

Athens Medical Center

Cardiac Catheterization Laboratory

4/3/2015

www.epemvatikikardiolgia.gr

Aortic Valve Anatomy

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Aortic Root Anatomy

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Causes of Aortic Stenosis

• Age related-Annular Calcification• History of Rheumatic Fever• Congenital Anomalies (Bicuspid Valve)• History of Chest Radiation• Autoimmune Diseases• Congenital Hypercholesterolemia• End-stage Renal Disease

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Incidence of Aortic and Mitral Valve Disease

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Natural History and Symptoms of Aortic Stenosis

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Aortic Stenosis Treatment Algorithm

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Choice of Surgival or Transcatheter Treatment of AS

Recommendations Class LOE

Surgical AVR in low or intermediate risk patients

I A

TAVI or high-risk Surgery should be performed under Heart Team Guidance

I C

TAVI for extremely high-risk patients + post TAVI predicted survival > 12 months

I B

TAVI alternative to SAVR for high-risk patients IIa B

BAV as a bridge to TAVI or SAVR IIb C

TAVI not recommended in patients with comorbidities which preclude benefit

III B

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PARTNER 1A-2 year Results

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PARTNER 1B-Extremely High Risk Pts

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US CoreValve Trial

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US CoreValve Trial

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US CoreValve Trial-Complications

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TAVI Candidates

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Worldwide TAVI Candidates

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Wordwide TAVI Incidence Candidates

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Edwards-Sapien XT Valve

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CoreValve

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Valves Under Evaluation

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Valve Delivery Systems

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Preclose technique

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TAVI Route

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TAVI Screening

• Euroscore > 20%• STS Score > 10%• Echocardiogram• Coronary Angiography• CT Angiography (Aorta & Peripherals)

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CT Angiography (LVOT-Annulus-SOV-Aorta)

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CT Angiography (Peripherals)

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Screening Report

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Fluroscopic Image of Valve Release (CoreValve)

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Fluroscopic Image of Valve Release(Edwards-Sapien)

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Femoral Arterial Puncture (1)

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Femoral Arterial Puncture (2)

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Sheath Insertion (14-22 F)

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Baseline Aortography

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Aortic Valvuloplasty

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Valve Delivery System

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Initial Valve Release (CoreValve)

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Final Valve Release (CoreValve)

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Femoral Angiography after closure

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TAVI Vascular Arterial Complications

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TAVI Transapical Complications

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TAVI Mitral Valve Injury

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TAVI Paravalvular Regurgitation

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TAVI Annulus Rupture

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TAVI Coronary Obstruction

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Θερμές Ευχαριστίες (2015)

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Κατερίνα-Βασίλης Αριέττα

Φίλιππος